MIH Supplementation Strategies

Abstract

The use of calcium-phosphate casein on hypomineralized molars (molar incisor hypomineralization, MIH) has been proposed but not clinically investigated. Qualitative and quantitative effects of supplementation with a calcium-phosphate casein product on MIH molars were monitored over a period of three years. Molar replicas, minimally invasive biopsies and their SEM microphotographs, plus ESEM/EDX semi-quantitative peaks of elements present in affected enamel were evaluated. Mineralization, morphology, and porosity appeared markedly improved, with calcium and phosphate levels reaching almost normal levels at three years' follow-up. The hypothesis tested was rejected, since calcium-phosphate casein improved enamel morphology in vivo.

An Innovative Approach to Treat Incisors Hypomineralization (MIH): A Combined Use of Casein Phosphopeptide-Amorphous Calcium Phosphate and Hydrogen Peroxide—A Case Report

“…MIH opacities have a total reduced mineral content (about 20% of the weight) and a relative increase in organic substance [2, 7, 8]; its remineralization with conventional or new aids, like fluoride or CCP-ACP, is an arduous and slow proceeding. Microabrasion and/or composite resin restorations are the most used solutions to improve aesthetics of anterior teeth affected by opacities, but these approaches are quite invasive.…”

“…The use of bleaching systems on hypomineralized teeth is not recommended because of mineral changes caused by peroxides especially on enamel presenting an increase in carbon content and a decrease in calcium and phosphate content [2]. During a bleaching treatment, peroxides initiate oxide-reduction reaction that may lead to dissolution of both organic and inorganic matrices [9].…”

“…CCP-ACP has, also, been shown to be effective in remineralization of MIH opacities in vivo , helping functional restorative techniques in MIH molars and aesthetics in untreated incisors [2]. Up to date it has never been investigated the possibility to treat MIH opacities using bleaching system combined with CCP-ACP mousse.…”

“…Scanning electron microscope and semiquantitative analysis by Energy Dispersive X-ray Spectrometry showed that affected enamel is not organized in hydroxyapatite crystals and it is low in calcium and phosphate ions [2]. …”

“…This reservoir of ions, under acid challenge, maintains a supersaturated mineral environment, reduces demineralization, and enhances remineralization of enamel [3]. CPP-ACP supplementation has been shown to be effective in remineralization of the enamel affected by MIH, resulting in an aesthetic improvement too [2]. However, this clinical approach requires a long-time treatment that could last months or years, requiring patients' cooperation.…”